Defense Sexual Assault Incident Unrestricted Reporting

Defense Sexual Assault Incident Reporting

Documents and Forms

Document Name Document Type
Form DD Form 2965 Defense Sexual Assault Incident Unrestricted Reporting Form
DD Form 2965 Defense Sexual Assault Incident Database (DSAID) Data Fo DD2965 draft 20211014.pdf Form
DD Form 2910 Victim Reporting Preference Statement DD2910 draft 20220110.pdf Form

Information Collection (IC) Details

IC Title:	Defense Sexual Assault Incident Unrestricted Reporting	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DD Form 2965	Defense Sexual Assault Incident Database (DSAID) Data Form	DD2965 draft 20211014.pdf		Yes	Yes	Fillable Fileable
Form	DD Form 2910	Victim Reporting Preference Statement	DD2910 draft 20220110.pdf		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: DHRA 06 Defense Sexual Assault Incident Database	FR Citation: 79 FR 38534

Number of Respondents: 5,640	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,640	4,942	698
Annual IC Time Burden (Hours)	14,100	12,355	1,745
Annual IC Cost Burden (Dollars)	370,999	325,085	45,914

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.